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Kandzari DE, Townsend RR, Bakris G, Basile J, Bloch MJ, Cohen DL, East C, Ferdinand KC, Fisher N, Kirtane A, Lee DP, Puckrein G, Rader F, Vassalotti JA, Weber MA, Willis K, Secemsky E. Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF. Catheter Cardiovasc Interv 2021; 98:416-426. [PMID: 34343406 DOI: 10.1002/ccd.29884] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 12/19/2022]
Affiliation(s)
- David E Kandzari
- Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Raymond R Townsend
- Hypertension, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - George Bakris
- Hypertension, University of Chicago Medicine, Chicago, Illinois, USA
| | - Jan Basile
- Cardiology, Medical University of South Carolina and Ralph H. Johnson VA Medical Center to Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael J Bloch
- Vascular Care, Renown Institute for Heart and Vascular Health, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Debbie L Cohen
- Hypertension, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cara East
- Cardiology, Baylor Heart & Vascular Hospital, Dallas, Texas, USA
- Vascular Intervention, Soltero CV Research Center, Texas A&M College of Medicine
| | - Keith C Ferdinand
- Preventive Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Naomi Fisher
- Hypertension, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ajay Kirtane
- Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York, USA
| | - David P Lee
- Interventional Cardiology, Stanford University, Stanford, California, USA
| | - Gary Puckrein
- The National Minority Quality Forum, Washington, District of Columbia, USA
| | - Florian Rader
- Hypertension Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Joseph A Vassalotti
- Clinical Professor, Icahn School of Medicine at Mount Sinai, National Kidney Foundation, New York, New York, USA
| | - Michael A Weber
- Cardiovascular Medicine, SUNY Downstate Medical Center, New York, New York, USA
| | - Kerry Willis
- National Kidney Foundation, New York, New York, USA
| | - Eric Secemsky
- Vascular Intervention, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Salman LA, Cohen DL. Chronic kidney disease in adrenal disorders. Curr Opin Endocrinol Diabetes Obes 2021; 28:312-317. [PMID: 33741779 DOI: 10.1097/med.0000000000000629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review will focus on hypertension due to underlying adrenal disorders in chronic kidney disease (CKD). Diagnosis of adrenal hypertension and particularly primary aldosteronism (PA) in CKD is frequently not pursued. We outline limitations that advanced kidney disease poses on the diagnostic work up of these disorders and provide a framework for approaching CKD patients suspected of having an adrenal disorder. Recognition of these disorders is important as they are often underdiagnosed which leads to poorer outcomes. RECENT FINDINGS Adrenal disease associated with hypertension in CKD is most commonly due to PA whereas pheochromocytoma and Cushing's disease are important but less common. Diagnosis of these diseases is important as their identification leads to better blood pressure control and can possibly mitigate the risk of progression of CKD. Work up and treatment of PA has been shown to be safe and is associated with less antihypertensive medication requirement for the associated hypertension and slower progression of CKD. SUMMARY This chapter summarizes the importance of recognizing adrenal hypertension in CKD and reinforces the need for physicians to pursue these diagnoses in CKD patients as this is safe and improves both BP control and delays progression of CKD.
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Affiliation(s)
- Liann Abu Salman
- Perelman School of Medicine at the University of Pennsylvania, Renal, Electrolyte and Hypertension Division, Philadelphia, Pennsylvania, USA
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Abstract
Primary aldosteronism (PA) is a common cause of secondary hypertension caused by excessive and inappropriate secretion of the hormone aldosterone from one or both adrenal glands. The prevalence of PA ranges from 10% in the general hypertensive population to 20% in resistant hypertension, yet only a small fraction of patients is diagnosed. Disease and symptom recognition, screening in indicated populations, multidisciplinary communication, and appropriate imaging and biochemical workup can identify patients who might benefit from effective and targeted treatment modalities. Effective treatments available include both surgical and medical approaches, usually dependent on the subtype of PA present. Our collective understanding of the pathophysiology of PA is expanded by recent developments in molecular biology and genetics, including understanding the specific somatic and germline mutations involved in pathogenesis. We review the pathophysiology, diagnostic workup, and treatment considerations for this disease process.
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Affiliation(s)
- Sean M Wrenn
- Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of General Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carrie C Lubitz
- Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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